Dental Benefits
Insurance Provider:
United Health Care Group# 681496
Waiting Period:
1st of Month Following 30 Days
Insurance Costs & Breakdown:
Employee Only Coverage
Total Annual Cost
$348.36
Employer Annual Cost
$348.36
Employee Annual Cost
$0.00
Employee Cost Per Paycheck
$0.00
Employee + Spouse Coverage
Total Annual Cost
$696.84
Employer Annual Cost
$348.36
Employee Annual Cost
$348.48
Employee Cost Per Paycheck
$13.40
Employee + Child(ren)Coverage
Total Annual Cost
$729.12
Employer Annual Cost
$348.36
Employee Annual Cost
$380.76
Employee Cost Per Paycheck
$14.64
Employee + Family
Total Annual Cost
$1,113.00
Employer Annual Cost
Employee Annual Cost
$348.36
$764.64
Employee Cost Per Paycheck
$29.41
Plan Type:
Calendar Year Max:
Deductible:
Preventative Services:
Included:
Basic Services:
Includes:
Major Services:
Includes:
Orthodontia:
Coinsurance/Max:
DPPO
$1,000
$50 (Ind) $150 (Fam)
100% Ded. Waived
Exams & Cleanings (2yr), X-Rays, Lab & Other Diagnostics Tests, Child Only Fluoride & Space Retainers
80% After Ded.
Filings, Simple & Surgical Extractions, Oral Surgery, Endo/Perio, Emergency Treatment
50% After Ded.
Inlays, Onlays, Crowns*, Dentures, Bridges*
Not Covered
0% After Ded $1,500 Lifetime
*Your plan bases reimbursement on the least costly treatment alternative. A pre-treatment estimate is recommend for any service over $500.00.